The Doctors and the Discipline

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by Kenneth Bagnell

According to a saucy story, a cynical American was visiting friends when the conversation turned to the difference in medical treatment between the US and Britain. The US man grunted that in his country “a physician is a person who kills illness with pills, then kills the patient with bills.” (I’m glad I’ve never been ill in the United States.) A couple of days ago, after I opened our daily paper, The Toronto Star, I almost lost my breath. Why? Because page after page claimed incompetence or indifference by a great many of our physicians. It struck me as a stunning shock simply because most of us look up to doctors rather than down upon them. Given that, what a surprise it was when I read the huge front page that headlined: “Bad Doctors.” The Star keeps it going and going so that today’s lead editorial claims that American doctors head to Canada. The reason? Here it is: “Doctors who have been disciplined by American medical boards can saunter back across the broader to set up shop and, thanks to Canada’s secretive regulatory bodies, their Canadian patients may be none the wiser.” (Don’t the doctors adore and then fawn over The Toronto Star!)

I did some searching and found in The Star’s lengthy article occupying virtually the entire front page, and filling both pages six and seven. More importantly I could not locate – as I did with the US – a serious and lengthy ethical statement. For example if I attempted to record the Code of Ethics of the AMA (American Medical Association) I would be have to give the entire afternoon to recording and grasping its full meaning. Let me just list a few of the “public commandments” that must be followed if you practice below the border, some being obvious without needing listing:

(4) A physician will respect the rights of patients and colleagues….A physician shall continue to study…

(5) A physician shall… be free to choose who to serve and whom to associate with…

(6) A physician shall, while caring for a patient, regard responsibility to the patient as paramount…

(7) A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community…

(8) A physician shall support access to medical care for all people

Don’t conclude that I naively accept these “commandments” as fulfilled by every single American physician, a profession which in the US numbers roughly 767,000. (There’s actually a shortage of 7,000.) Nor have I since my childhood had a family physician I suspected as incompetent, or unethical. But an American document I’ve located says there is a problem and it’s mentioned in one of the most professional of American publications, The Atlantic. In an article touching on medical standards and physician attitudes the piece claims: “The result too often fails the people it’s prepared to help.” That I propose may well be the truth.

That said, The Star’s recent front page, along with its lengthy article on questionable physicians, is bound to raise great indignation in Canada’s medical circles. What is likely to happen, in my own judgement is that the medical culture will downplay what The Star has carried on the basis that the “people” who gathered this material are simply non-professionals and thereby should not be taken seriously. In any case, as a person who has been on the editorial board of both The Star and The Globe & Mail, I’m absolutely certain that these very serious front page stories have been, as we used to call it, “lawyered, and then “lawyered” again.

In brief, those who read or don’t read The Star might well prepare as we include here the most headshaking headlines I’ve ever read, being almost enough to make me drop everything in hands and head: “BAD DOCTORS who cross the border can hide their dirty secrets. WE DUG THEM UP.” For those across the country who wonder what it’s all about we sum it up: obviously the American border and the very first sentence will give you the essence of the story: “In Bellingham, Washington, family physician (he’s named) raped a pregnant patient in his office, the state’s medical commissioned ruled…. In Duluth, Minnesota, Neurosurgeon so and so has patients who complain of mistakes that caused serious injuries including quadriplegia and the death of a young mother, triggering regularly sanctions and several malpractice payouts… In San Diego, California, a children’s kidney specialist pleaded guilty to possessing sexually explicit photos of boys. The judge who sentenced him to 15 months in prison called the images sadistic…. Now, I give you more bad news: Every physician I just mentioned (without his name) was Canadian-trained and all have returned to Canada. Does that make you proud?

So what provokes it? To me, it may well be a product of the times we live in. What does that mean? In large part, but not entirely it’s the culture of secularism. No admonitions and never mind those old fashioned ten commandments, or Judaic-Christian morality. In most families today it’s do what you want to do so long as its legal, or hid well from legality. It’s just one step and before long we’ll have abusers wanting heroin, and if a doctor is not ethical he just night take out the needle. As for the ten commandments, they are on their way to become part of history, In short, sorry to say, the past is on its way to the past.